Infecções oportunistas relacionadas ao vírus da imunodeficiência humana (HIV)
Resumen
Definition
History and exam
Key diagnostic factors
- ausência de terapia antirretroviral (TAR) ou falha da TAR
- febre
- cefaleia e estado mental alterado
- dispneia ou tosse
- dor abdominal, diarreia, perda de peso
- disfagia
- linfadenopatia
- moscas volantes, dor ocular e cegueira
- hemorragia ocular
- alterações na mucosa
Other diagnostic factors
- hepatoesplenomegalia
- dessaturação de oxigênio induzida por exercício
- visão turva e fotofobia
- papiledema
- meningismo, achados neurológicos focais
- dor e fraqueza
- dor nos ossos e nas articulações
- lesões cutâneas
Risk factors
- soroconversão pós-HIV com qualquer contagem de CD4
- Contagem de CD4 abaixo de 250 células/microlitro
- Contagem de CD4 abaixo de 200 células/microlitro
- Contagem de CD4 abaixo de 150 células/microlitro
- Contagem de CD4 abaixo de 100 células/microlitro
- Contagem de CD4 abaixo de 50 células/microlitro
- ausência de terapia antirretroviral (TAR) ou falha da TAR
- homens que fazem sexo com homens (HSH)
- raça negra ou hispânicos
- uso de substâncias por via intravenosa
- fatores socioeconômicos (pobreza, aglomerações, desabrigados, desnutrição)
- inalação de poeira em áreas endêmicas de Coccidioides e Histoplasma
Diagnostic tests
1st tests to order
- contagem de células CD4
- coloração e cultura do escarro
- hemoculturas
- adenosina desaminase
- sorologia para Toxoplasma gondii
- Sorologia para Coccidioides
- antígeno polissacarídeo criptocócico
- Antígeno de Histoplasma capsulatum
- Cultura de Histoplasma capsulatum
- Hemograma completo
- testes da função hepática
- lactato desidrogenase (LDH)
- gasometria arterial
- radiografia torácica
- tomografia computadorizada (TC) de crânio
Tests to consider
- teste de amplificação de ácido nucleico de tuberculose (TB)
- ensaio de lipoarabinomanano de fluxo lateral na urina (LF-LAM)
- lavagem broncoalveolar (LBA)
- raspagens orofaríngeas (solução de hidróxido de potássio [KOH]) e cultura
- Análise do líquido cefalorraquidiano (LCR)
- reação em cadeia da polimerase: líquido cefalorraquidiano (LCR), líquido de lavagem broncoalveolar (LBA) e amostra de humor vítreo e aquoso para Toxoplasma gondii
- aspirado e cultura da medula óssea
- aspirado ou biópsia de linfonodos
- biópsia tecidual
- biópsia do cérebro
- tomografia computadorizada (TC) abdominal
- TC de alta resolução (TCAR) do tórax
- reação em cadeia da polimerase para pneumonia por Pneumocystis jirovecii (PPC)
- beta-D-glicano
- ressonância nuclear magnética (RNM) cranioencefálica
- tomografia computadorizada por emissão de fóton único com tálio e PET
- endoscopia digestiva alta e colonoscopia
- teste de antígeno coccidioidal
- reação em cadeia da polimerase para Coccidioides
- reação em cadeia da polimerase para Histoplasma
Treatment algorithm
Infecção por Mycobacterium tuberculosis
complexo M avium disseminado
Pneumonia por Pneumocystis jirovecii
Encefalite por Toxoplasma gondii
meningite criptocócica
citomegalovírus
candidíase mucocutânea
coccidioidomicose
Histoplasmose disseminada
Contributors
Authors
Jake Scott, MD
Clinical Associate Professor
Infectious Diseases and Geographic Medicine
Stanford University School of Medicine
Antimicrobial Stewardship Program Medical Director
Stanford Health Care Tri-Valley
Pleasanton
CA
Disclosures
JS declares that he has no competing interests.
Acknowledgements
Dr Jake Scott would like to gratefully acknowledge Dr, Ruth Byrne, Dr Mark Nelson, and Dr Irene Alexandraki, previous contributors to this topic.
Disclosures
RB, MN, and IA declare that they have no competing interests.
Peer reviewers
Thomas B. Campbell, MD
Professor of Medicine
University of Colorado Anschutz
Aurora
CO
Disclosures
Unpaid member of the US DHHS Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV and the National Comprehensive Cancer Network Guidelines for Cancer in People with HIV and Kaposi Sarcoma.
Ellen Kitchell, MD, FIDSA, AAHIVM-S
Associate Professor
University of Texas Southwestern
Dallas
TX
Disclosures
EK declares that she has no competing interests.
Colm O'Mahony, MD, FRCP, BSc, DIPVen
Consultant in Sexual Health
Department of Sexual Health
Countess of Chester Hospital NHS Foundation Trust
Chester
UK
Disclosures
CO declares that he has no competing interests.
Nicola Steedman, MRCP, DipGUM, DipHIV
Consultant Physician in Sexual Health and HIV
Department of Sexual Health
Countess of Chester Hospital NHS Foundation Trust
Chester
UK
Disclosures
NS declares that she has no competing interests.
William R. Rodriguez, MD
Assistant Professor of Medicine
Massachusetts General Hospital
Charlestown
MA
Disclosures
WRR declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. 2025 [internet publication].Full text
World Health Organization. Guidelines for diagnosing, preventing and managing cryptococcal disease among adults, adolescents and children living with HIV. Jun 2022 [internet publication].Full text
Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007 Feb 15;175(4):367-416.Full text Abstract
Wheat LJ, Freifeld AG, Kleiman MB, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007 Oct 1;45(7):807-25.Full text Abstract
Chang CC, Harrison TS, Bicanic TA, et al. Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM. Lancet Infect Dis. 2024 Aug;24(8):e495-512.Full text Abstract
Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62(4):e1-50.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Pneumonia
- Diarreia
- Meningite
More DifferentialsGuidelines
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV
- Antiretroviral drugs for treatment and prevention of HIV in adults: 2024 recommendations of the International Antiviral Society–USA panel
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